Anaesthesia for patients with an abdominal aortic aneurysm

The intraoperative anaesthetic management of patients with an abdominal aortic aneurysm (AAA) remains a challenge to the anaesthetist. The immediate operative morbidity/mortality of elective patients has in recent decades been lowered. Long-term results are influenced above all by the presence of concomitant cardiovascular disease engaging all vital functions: heart, brain and kidneys. Many of the AAA patients are also obese and heavy smokers and have diabetes. The AAA patient presenting as an emergency with a ruptured or leaking aneurysm has a very high mortality which has not changed much even with the introduction of more sophisticated anaesthetic regimens or monitoring devices. Patients are operated on either during general anaesthesia alone or in combination with spinal/epidural anaesthesia. There are pros and cons with both methods. Potential complications although seldom occurring with epidural blockade following heparinization must be borne in mind. Long-term results have not been dependent on the method chosen, but epidural analgesia might make the post-operative period smoother and allow earlier mobilization of patients. In the last 10 years abdominal aortic aneurysms have also been repaired with endoluminal surgical techniques using stents. Primarily these methods were intended for patients considered too sick to undergo open repair. In principle the patients can be operated on under local analgesia with sedation. Endoluminal surgery has not reduced operating time or overall costs owing to the necessary follow-up of patients with for example angiography. The long-term results are identical to those of the older methods, probably because of a continuation of the underlying cardiovascular disease. However, newer methods are evolving and the surgical skills are improving.